SARS-CoV-2 environmental contamination from hospitalised patients with COVID-19 receiving aerosol-generating procedures. Issue 3 (4th November 2021)

• Record Type: Journal Article
• Authors: Winslow, Rebecca L; Zhou, Jie; Windle, Ella F; Nur, Intesar; Lall, Ranjit; Ji, Chen; Millar, Jonathan Edward; Dark, Paul M; Naisbitt, Jay; Simonds, Anita; Dunning, Jake; Barclay, Wendy; Baillie, John Kenneth; Perkins, Gavin D; Semple, Malcolm Gracie; McAuley, Daniel Francis; Green, Christopher A
• Is Part Of: Thorax. Volume 77:Issue 3(2022)
• Page Start: 259
• Page End: 267
• Publication Date: 2021-11-04
• Subjects: COVID-19 -- non invasive ventilation; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2021-218035
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Continuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) are considered 'aerosol-generating procedures' in the treatment of COVID-19. Objective: To measure air and surface environmental contamination with SARS-CoV-2 virus when CPAP and HFNO are used, compared with supplemental oxygen, to investigate the potential risks of viral transmission to healthcare workers and patients. Methods: 30 hospitalised patients with COVID-19 requiring supplemental oxygen, with a fraction of inspired oxygen ≥0.4 to maintain oxygen saturation ≥94%, were prospectively enrolled into an observational environmental sampling study. Participants received either supplemental oxygen, CPAP or HFNO (n=10 in each group). A nasopharyngeal swab, three air and three surface samples were collected from each participant and the clinical environment. Real-time quantitative polymerase chain reaction analyses were performed for viral and human RNA, and positive/suspected-positive samples were cultured for the presence of biologically viable virus. Results: Overall 21/30 (70%) participants tested positive for SARS-CoV-2 RNA in the nasopharynx. In contrast, only 4/90 (4%) and 6/90 (7%) of all air and surface samples tested positive (positive for E and ORF1a) for viral RNA respectively, although there were an additional 10 suspected-positive samples in both air and surfaces samples (positive for E or ORF1a). CPAP/HFNO use or coughing was not associated with significantly more environmental contamination than supplemental oxygen use. Only one nasopharyngeal sample was culture positive. Conclusions: The use of CPAP and HFNO to treat moderate/severe COVID-19 did not appear to be associated with substantially higher levels of air or surface viral contamination in the immediate care environment, compared with the use of supplemental oxygen.